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Reimbursement News

HHS must eliminate the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by the end of the 2022 fiscal year, according to a recent court order.
Judge James E. Boasberg of the US District Court for the District of...

Finalizing the consolidation of Medicare billing codes for evaluation and management (E/M) outpatient and office visits is the first step for CMS as the federal agency modernizes the payment structure for office visits, CMS Administrator...

The American Hospital Association (AHA), along with the Association of American Medical Colleges (AAMC) and their member hospitals, plan to bring a lawsuit against CMS for recently released site-neutral payment rules for hospital clinic...

CMS recently finalized a new value-based payment system for home health agencies that would move Medicare reimbursement away from the volume of therapy delivered.
Medicare will start to reimburse home health agencies under the...

Healthcare prices not only significantly varied across metro areas, but also within metro areas, a new analysis from the Health Care Cost Institute (HCCI) showed.
In its first report part of the Healthy Marketplace Index (HMI) project,...

CMS recently announced that it will be awarding up to $64.6 million to 12 state Medicaid agencies to help develop Medicaid reimbursement and care delivery strategies for maternal opioid misuse treatment.
The awards are part of the new...

Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in 2019.
The Oct. 18, 2018 letter to CMS...

About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a new analysis shows.
The 200...

A new report from the HHS Office of the Inspector General (OIG) reveals “widespread and persistent problems” related to prior authorization and claim denials in Medicare Advantage.
Using Medicare Advantage data on denials,...

Manual claims management processes significantly slow down time to reimbursement. However, payer enrollment services can help healthcare organizations digitize the key claims management step to reduce the amount of time providers spend...

Providers are calling on CMS to not finalize a proposal to collapse Medicare reimbursement for evaluation and management (E/M) visits into a single, blended payment rate for E/M Levels 2 through 5 visits.
In a recently proposed rule for...

Predictive analytics are key to implementing an effective and efficient claim denials management strategy that tackles the right denials at the right time, according to the Vice President of Revenue Cycle at Tennessee’s RCCH...

Payer enrollment services help healthcare organizations to unravel the complex process of credentialing providers and enrolling them in payer networks.
Payer enrollment is the process of a provider joining a health insurance plan’s...

The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services.
The 2019 CPT code set...

Eliminating the concept of long-term care hospitals (LTCHs) would save Medicare $4.6 billion per year without harming patient outcomes, a new National Bureau of Economic Research working paper found.
Medicare savings would stem from the...

Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting clinical advancements, but a...